Temperature increase in newborns and infants
It is widely believed among pediatricians that the smaller the child, the more attention it requires in the presence of fever. There are a number of reasons why fever in young children is more important and more alarming than in older children.
The body of a newborn and an infant has less ability to develop fever, and therefore it is quite reasonable to assume that when a child develops a fever, it is probably caused by a serious illness. The ability to limit and localize infection in children during the first months of life is reduced, so they are more likely to develop meningitis and other complications.
This is probably a consequence of the immaturity of the immune system, both in terms of the systemic response and due to the lack of a bank of immunological memory. In addition, it is difficult to diagnose the uncertainty of the clinical picture of the disease in such small patients. An example of this is the absence of stiffness in the newborns and infants with purulent meningitis or the absence of cough in newborns with pneumonia.
Fever, especially high, in the first months of life is much less common than at an older age. In a prospective study conducted by Teele, out of 600 children with a temperature of 38.3 ° C or higher, observed in the clinic, 213 patients were between 6 and 12 months old and only 116 children were under 6 months old (children under 4 weeks old were not counted) .
In his prospective work, McCarthy examined 330 children aged less than 2 years old who were admitted to the emergency room with a temperature of 40 ° C and above. Only 5 of these patients (1.5%) were younger than 3 months. Tomlinson among 1500 patients observed by him revealed 108 confirmed cases of temperature of 40 ° C and above. However, only one child was younger than 6 months.
According to McCarthy, among 93 children admitted to the emergency room with a temperature of 41.1 ° C and above, there were no under 3 months. As already mentioned, in infants serious infectious diseases are often not accompanied by fever, which is associated both with the characteristics of the febrile reaction at this age, and with the fact that contact with infectious patients in infants is relatively less.
According to the literature, the incidence of bacteremia in febrile children in the first months of life is very different. So, Strickland of 237 febrile children under the age of 78 days revealed bacteremia in 4.6%; 14% of these children had severe bacterial infections, including sepsis, meningitis, urinary tract infection, and bacterial pneumonia. Roberts detected bacteremia in 9 out of 61 children, i.e., in 15% of the patients who had temperature for the first 8 weeks of life; in 8 cases out of 9 (group B streptococcus was isolated
According to McCarthy, 8.3% of febrile children under the age of 3 months observed in his clinic had pneumonia and 1.8% had meningitis. The frequency of bacteremia in this observation was 0.7% among all children with fever and 4.5% among children with a temperature of 40 ° C and higher. In 13% of febrile children younger than 3 months he observed severe infectious diseases, which corresponds to Strickland data.
These data show that fever in the first 2-3 months of life is relatively rare, but if it develops, it is usually significant and indicates the seriousness of the disease.